Breastfeeding Challenges, Support, and Information (Plus Practical Tips from Lots of Moms Who Have Breastfed Successfully)

If everyone seems to agree that breast milk is the ideal nutrition for babies, then why is this topic so touchy? To better understand the sensitivities involved, let’s take a closer look at breastfeeding issues for women today.

Women working outside the home: Women are working more hours outside the home than ever before, yet the pressure to breastfeed has skyrocketed, especially when compared to previous generations.
Increased breastfeeding rates: Today, breastfeeding initiation rates are 83%, up from 24% in the early 1970s.³⁹
Cultural expectations to breastfeed: The last few years have seen major increases in social and cultural pressure to breastfeed. A tax deduction exists for breast pumps and other supplies (formula supplies do not qualify), while photos of breastfeeding celebrities appear in the same news feeds as major world events—first, a stand-off in the Ukraine, followed by Gisele Bündchen lounging in her bathrobe, nursing her baby with a glam squad in attendance. This is all great news for babies, but a working mom pumping in a storage closet or small back office with co-workers snickering outside may sense that certain expectations for breastfeeding might be unrealistic.

Note: I get Gisele’s heartfelt message behind this photo.

Now that we have all re-calibrated, let’s dive into the full spectrum of breastfeeding, including the good, the bad, and the bumps in the road. Because understanding the complex nature of this topic may help us all better achieve our goals.

The Good: Benefits of breastfeeding

Breast milk is made especially for baby.
It is easier to digest than the protein in cow’s milk, and it helps fight disease.
Colostrum, also called “liquid gold,” is the thick, yellow breast milk that you make during pregnancy and just after birth. This milk is rich in nutrients and antibodies that protect your baby for life. Colostrum changes into mature milk by three to five days after birth, and this milk has just the right amount of fat, sugar, and protein to help baby grow.
Formula cannot match the precise chemical makeup of human breast milk.⁴⁰
Breastfeeding provides instant, healthy food, without bottles to sterilize or warm at night.
It is also less expensive than formula feeding and beneficial to Mom. Formula and bottle supplies can cost over $1,500 per year, whereas breastfeeding is nearly free (though most women will probably need a breast pump.)
Moreover, breastfed babies are sick less often, which can lower health care costs.
Breastfeeding is also linked to a lower risk of certain diseases in women, including postpartum depression, breast cancer, ovarian cancer, and Type 2 diabetes.
Breastfeeding is linked with a healthier range of weight gain for young children and increased rates of breastfeeding in the last decade are credited with reducing obesity for children ages 2-5.
Other studies link breastfeeding to higher IQ, lower rates of osteoporosis, and less postpartum bleeding.^{41, 42}

Common Breastfeeding Challenges

I have hardly met a nursing mom who didn’t have breastfeeding challenges, and more often than not, low milk supply is a major concern. Common issues such as sore nipples, inverted nipples, and problems with baby’s latch can all lower milk supply. A good latch occurs when baby’s mouth covers more of the areola above the nipple than below, like a fish kissing a wall.

The Bad Latch Cycle

A bad latch can lead to a cycle of frustration, which adversely affects the overall breastfeeding effort; a bad latch causes sore nipples, Mom is edgy with sore nipples and baby is not gaining weight, so Mom or Dad panics and supplements with formula, which contributes to further low milk supply. Repeat. Some babies need supplementation during that initial low milk supply period. However, if this happens to you, please seek help from a lactation specialist.

Ninety-two percent of participants in a recent study reported at least one major breastfeeding concern in the first week. The top three concerns included:
difficulty with infant feeding,
breastfeeding pain, and
milk quantity.⁴⁷

Breastfeeding for preemies, multiples, or babies with health issues

Breastfeeding can be very difficult with preemies, multiples, or babies with health issues. If your baby is whisked away to the Neonatal Intensive Care Unit (NICU) immediately after birth, try not to worry about the guidelines for breastfeeding within the first hour. Pumped breast milk can be fed through a tube, and nursing isn’t the only form of bonding. Bonding starts long before your baby is born. One study found that not only could three-day-old infants recognize the smell of their mother’s amniotic fluid, but that smell was soothing prior to experiencing pain, such as a heel prick.⁴³ Another study found that newborn babies less than three days old prefer their mothers’ voices to those of strangers.⁴⁴

Breastfeeding and working moms

Some women find that breastfeeding is easier than expected at first, but then meet challenges after returning to the office. For example, leaking breast milk on a t-shirt at home is not exactly the same as drenching a silk blouse during a meeting at work. Some new moms may also be concerned about time allowances for pumping during the workday. Yet many do not know that federal regulations are on their side.

Did You Know?

Break Time Laws for Nursing Mothers

The Patient Protection and Affordable Care Act (“Affordable Care Act”) amended section 7 of the Fair Labor Standards Act (“FLSA”), requiring “employers to provide reasonable break time for an employee to express breast milk for her nursing child for one year after the child’s birth each time such employee has need to express the milk. Employers are also required to provide a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk.” This breastfeeding break time requirement became effective when the Affordable Care Act was signed into law on March 23, 2010.

Getting Over the Hump: Troubleshooting Tips

Surveys often cite “lack of support” as a catch-all reason why women give up on breastfeeding, so let’s flesh out a few common scenarios and provide some troubleshooting tips and solutions.

Lack of role models

Problem: New mothers often get information about breastfeeding from pamphlets and online resources, which can be ineffective compared to live role models, such as family and friends who have breastfed successfully.

Solution: If you want to breastfeed, seek the help of trusted friends and family members who have been successful breast feeders.

Generational differences

Problem: At birth, a new mom’s own mother may be ambivalent about breastfeeding. She didn’t breastfeed, and you turned out fine (breastfeeding rates in the 1970s and 80s were between 25-35%).

Solution: Assure your mom that you respect her decisions and ask for her support. Invite her to be present when you talk with a lactation consultant.

Lack of partner support

Problem: In some families, fathers may feel uncertain about breastfeeding. How will Dad bond with baby? How will his partner work outside the home and breastfeed? How much household work will shift to him due to breastfeeding? How will breastfeeding affect the couple’s sex life?

Solution: Prenatal education with fathers has shown to enhance breastfeeding support remarkably. One study from an urban university obstetrics practice showed a breastfeeding initiation rate of 74% among mothers whose partners attended a two-hour prenatal intervention class (led by a peer-educator), compared to a 41% rate among control groups without the class. Teach your partner about breastfeeding.⁴⁵

Mixed messages about breastfeeding in the media

Problem: If you peruse popular op-eds, you might come across cynical headlines about breastfeeding, such as “The Breastfeeding Myth,” “Booby Trap: Myths about Breastfeeding,” or “The Case against Breastfeeding.” In the last article, the author states, “it was not the vacuum that was keeping me and my 21^st-century sisters down, but another sucking sound.” Personally, I don’t get it. If you are going to rant and rave and spread cynicism about something, pick a better subject.

Solution: If you want to breastfeed successfully, surround yourself with positive and encouraging messages about breastfeeding.

Misperceptions about low milk supply

Fifty percent of women rank “insufficient milk supply” as the number one reason for stopping breastfeeding.⁴⁶

Problem: New mothers are often discouraged by the common misconception they are not producing enough milk for their baby when they actually are producing sufficiently. No one has explained the physiology of lactation.

Solution: Visual cues may help new mothers conceptualize just how much milk a baby needs per day in the first weeks of life, which is not that much. See the chart below.

Visual cues: size and volume of a newborn’s stomach

DAY ONE	DAY THREE	ONE WEEK	ONE MONTH
Size of a Cherry	Size of a Walnut	Size of an Apricot	Size of a Large Egg
5-7 ml or ½ tsp.	22-27 ml or .75-1 oz.	45-60 ml or 1.5-3 oz.	80-150 ml or 2.5-5 oz.

What if you just can’t breastfeed?

Some mothers simply cannot breastfeed or breastfeed exclusively, due to physical ailments, emotional limitations, medications, employment, and other factors. Know that good parenting is more important than breastfeeding. Your baby needs a healthy mom. So, if you are experiencing difficulties and you choose to give up breastfeeding, make lemonade from lemons and embrace the positives of formula feeding. Formula can be easier to feed on the go, with no worrying about nursing in public. With formula, you know exactly how much baby is eating and your schedule is not directly tied to baby. Other caregivers can also feed baby at night.

Breastfeeding Checklist

Learn as much as you can about breastfeeding. Dad can benefit from an overview, too. Some popular breastfeeding resources are:
- Online instructional videos: These Babycenter videos demonstrate breastfeeding techniques better than any book.
- La Leche League International: online information portal (http://www.llli.org) or telephone hotline 1-800-525-3243 from 9:00 a.m. to 5:00 p.m. CST.
- KellyMom website: peruse the information at www.KellyMom.com
- Breastfeeding Books: Read books on breastfeeding. such as The Womanly Art of Breastfeeding.

Overcome early breastfeeding discomfort with tenacity and a sense of purpose. The initial pain and discomfort of breastfeeding should subside in two to four weeks. Nursing can be relaxing and peaceful once established.
Overcome work schedule challenges with compromise. No one says that baby must be 100% breastfed, especially after Mom returns to work. Try to keep breastfeeding and supplement with formula if needed. For example, breastfeed at night and in the morning and have a care provider feed pumped milk supplemented with formula during the day. Pump what you can at work. Assess your baby’s feeding situation one day at a time and keep going as long as you can.

Optimize your nutrition. Check out this Breastfeeding Grocery List, prioritizing some of the most nutrient-dense foods for breastfeeding and summarizing essential nutrients for you and your baby.

Birth Control and Breastfeeding

Talk to your doctor about contraceptives and breastfeeding. Birth control pills with combined progesterone and estrogen are linked to changes in milk content and low milk supply. Progestin-onlycontraceptives, including “minipills” and Depo-Provera, are generally the preferred hormonal birth control for breastfeeding women.⁴⁸
Know that hormonal contraceptives are not your only birth control options.
- Nonhormonal methods: male and female condoms, diaphragm, copper intrauterine device, cervical cap, vaginal sponge, spermicidal cream or foam
- Hormonal methods: progestin-only contraceptives, combination progestin-estrogen contraceptives
- Lactational amenorrhea method (LAM): if you plan to breastfeed six months or longer, feed your baby 90 to 95% of his food intake from breast milk, and breastfeed every four hours in the day and every six hours at night, you can have a protection rate close to 98% for your first six months of breastfeeding.⁴⁹
- Permanent sterilization: vasectomy for a man, tubal ligation for a woman

Practical Tips from Real Parents: Breastfeeding

Relax! You and baby are learning how to do this thing called breastfeeding at the same time.
Know that breastfeeding is kind of like childbirth. When you talk to other women, they often remember the end result and forget the struggle it took to get there.
Feed as soon as you think baby is hungry (when she first starts rooting or turning her head and opening her mouth) and she will suck with less vigor.
Apply lanolin or nipple cream around the clock to help with cracked or bleeding nipples.
Express a tiny amount of breast milk on your nipples after feeding and rub all around the feeding area. Breast milk has antibodies that will speed up the healing. Go bra less to air dry.
Try a thin Medela nipple shield if baby is having problems latching and you are too sore to continue. It really helps!
Try these things for soreness and nipple pain: Booby Tubes gel packs (these go in the microwave for heat or the freezer for cool relief), Lansinoh Soothies gel pads, lanolin cream, and cold lettuce or cabbage leaves.
If you are struggling to feed, have a lactation consultant come to your house or attend a La Leche League meeting.
The more you breastfeed at first the more milk is made later.
Use a support pillow to breastfeed, or else you will be hunching over baby uncomfortably for as long as you feed.
Breastfeeding is rough on your back and neck. Your head is always looking down and you are curled up around baby to get in the right position. Make sure that you stretch and look up while feeding to minimize the strain.
Get comfortable breastfeeding. Lie on your side in bed with baby feeding, get in a recliner and relax, or use a wrap or sling to help support baby breastfeeding while you work on the computer, or do something else hands-free.
If you have clogged ducts frequently, try taking lecithin, a natural food additive, to reduce the stickiness of the milk.
If your baby continues to struggle with a good latch, have your pediatrician check to see if he is tongue-tied or has a physical reason why he can’t extend his tongue. The doctor can clip the frenulum, or webbed place under the tongue, to help with feeding.
If you have big breasts, make sure that you pinch or squeeze your nipple each time to help baby latch on. Also, don’t worry if baby’s nose is buried in your breast a little bit. He can still breathe since the nose tip usually extends further than the holes.
Your baby will tell you when she’s hungry. Look for her to turn her head, start opening and closing her mouth, and sucking naturally. This is when you should start feeding. Don’t be so rigid with your schedule that you miss baby’s cues.
Never wake a sleeping baby. Even though four hours have passed since his last feeding, let him sleep.
If you are trying to store up pumped milk for returning to work, pump in the morning when you have the most milk and during baby’s naps or longer feeding stretches.
Talk about your pumping schedule with your boss and co-workers up front (15-20 minutes every 3-4 hours). This way everyone will know what to expect, and they won’t panic when they can’t find you.
Rub olive oil on your breast pump flanges (the things that look like trumpets), if they are chafing you. Also, make sure the flanges are the right size for getting the most milk.
Contact your child’s pediatrician and your doctor to get treatment for thrush. Dump any pumped milk that may be infected. (Note: Thrush is a common yeast infection that can be shared between Mom and baby. It looks like white patches of cottage cheese in baby’s mouth and pink, flaky spots on mom’s nipples.)
Don’t trust the rhythm method or breastfeeding for birth control if you want to guarantee you will not get pregnant, especially if you are supplementing with formula. You will be fertile before you get your first period.

For more high-quality baby content, try the following articles:

Sources

39. Center for Disease Control and Prevention, Breastfeeding Report Card: United States 2014. 2014, National Center for Chronic Disease Prevention and Health Promotion.

40. DiSanto, J. Breast or Bottle? KidsHealth.org 2012.

41. Christakis, D.A., Breastfeeding and cognition: Can IQ tip the scale? JAMA Pediatr, 2013. 167(9): p. 796-7.

42. Brion, M.J., et al., What are the causal effects of breastfeeding on IQ, obesity and blood pressure? Evidence from comparing high-income with middle-income cohorts. Int J Epidemiol, 2011. 40(3): p. 670-80.

43. Varendi, H., et al., Soothing effect of amniotic fluid smell in newborn infants. Early Hum Dev, 1998. 51(1): p. 47-55.

44. DeCasper, A.J. and W.P. Fifer, Of Human Bonding: Newborns Prefer their Mothers’ Voices. Science, 1980. 208(4448): p. 1174-1176.

45. Wolfberg, A.J., et al., Dads as breastfeeding advocates: results from a randomized controlled trial of an educational intervention. Am J Obstet Gynecol, 2004. 191(3): p. 708-12.

46. Li, R., et al. Why mothers stop breastfeeding: mothers’ self-reported reasons for stopping during the first year. Pediatrics, 2008. 122 Suppl 2, S69-76 DOI: 10.1542/peds.2008-1315i.

47. Wagner, E.A., et al. Breastfeeding concerns at 3 and 7 days postpartum and feeding status at 2 months. Pediatrics, 2013. 132, e865-75 DOI: 10.1542/peds.2013-0724.

48. Guthmann, R.A., J. Bang, and J. Nashelsky, Combined oral contraceptives for mothers who are breastfeeding. Am Fam Physician, 2005. 72(7): p. 1303-4.

49. Kennedy, K.I. and C.M. Visness, Contraceptive efficacy of lactational amenorrhoea. Lancet, 1992. 339(8787): p. 227-30.